Jaw Diseases and Pain Management

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Questions and Answers

Which of the following is NOT a painful jaw disease?

Chronic gingivitis (correct)

Sickle cell infarcts

Fractures

Malignant neoplasms

Which condition can lead to pain in edentulous patients?

Denture trauma (correct)

Teeth grinding

Poor oral hygiene

Overzealous brushing

What is the primary cause of postoperative pain following dental procedures?

Alveolar osteitis (correct)

Improper anesthesia

Insufficient hydration

Overlapping dental procedures

Which of the following conditions is usually associated with pain induced by mastication?

Diseases of the teeth (B) Signup and view all the answers

What type of pain is trigeminal neuralgia characterized by?

Paroxysmal and severe sharp pain (A) Signup and view all the answers

Which of the following conditions triggers glossopharyngeal neuralgia?

Mastication (C) Signup and view all the answers

Which disease can cause referred pain from extra-oral sources?

Carcinoma of the maxillary antrum (D) Signup and view all the answers

What common stimulus can provoke an attack in trigeminal neuralgia?

Touching a trigger zone (A) Signup and view all the answers

What is epiphora primarily associated with?

Excessive and erratic lacrimal secretion (D) Signup and view all the answers

Which symptom is NOT part of the triad for myofascial pain dysfunction?

Facial swelling (C) Signup and view all the answers

Which factor is most commonly associated with the predisposition to myofascial pain dysfunction?

Physical trauma (C) Signup and view all the answers

What characterizes psychogenic (atypical) facial pain?

Poorly localized pain (A) Signup and view all the answers

Which age group is primarily affected by myofascial pain dysfunction?

Teens to 40 years (C) Signup and view all the answers

Which is a common extraoral symptom associated with myofascial pain dysfunction?

Neck aches (A) Signup and view all the answers

In diagnosing psychogenic facial pain, which approach is emphasized?

Diagnosis by exclusion (A) Signup and view all the answers

What symptom is characteristic of pain in psychogenic facial pain?

Unchanging pain for years (D) Signup and view all the answers

What may be a cause of persistent neuralgia in patients with trigeminal herpes zoster?

Post herpetic neuralgia (C) Signup and view all the answers

Which symptom is typically present in Bell's palsy?

Inability to smile on the affected side (A) Signup and view all the answers

What is a significant diagnostic feature suggesting an intracranial lesion related to facial pain?

Associated sensory loss with cranial nerve palsies (A) Signup and view all the answers

Which age group is commonly affected by Bell's palsy?

Adults aged 20-50 (D) Signup and view all the answers

What is a common initial symptom that may precede facial paralysis in Bell's palsy?

Numbness in the side of the tongue (B) Signup and view all the answers

What is a characteristic feature of pain in post herpetic neuralgia compared to trigeminal neuralgia?

Persistent pain that varies in intensity (B) Signup and view all the answers

What might be observed during a clinical examination of a patient with Bell's palsy when asked to close their eyes?

Eyeball rolls up but lids can't close on affected side (B) Signup and view all the answers

What is a rare but potential cause for pain similar to trigeminal neuralgia?

Intracranial tumors (B) Signup and view all the answers

What is a common characteristic of burning mouth syndrome?

Pain described as burning (A) Signup and view all the answers

Which of the following is NOT a feature of burning mouth syndrome?

Visible organic disease (D) Signup and view all the answers

Psychogenic dental pain often presents with pain localized in which area?

One tooth or a row of teeth (C) Signup and view all the answers

How do most patients with burning mouth syndrome typically respond to analgesics?

No response (C) Signup and view all the answers

What type of practitioner is generally needed for patients with unresolved psychogenic dental pain?

Psychiatric assessment (C) Signup and view all the answers

What demographic is most commonly affected by burning mouth syndrome?

Middle-aged or older women (C) Signup and view all the answers

Patients experiencing burning mouth syndrome may report which additional symptom?

Bitter or metallic taste (B) Signup and view all the answers

In cases of atypical odontalgia, what often happens if a tooth is extracted?

Pain moves to an adjacent tooth (A) Signup and view all the answers

What is the primary characteristic of somatic pain?

The cause is always apparent. (A), It is localized at the affected region. (D) Signup and view all the answers

Which type of pain is usually chronic and related to abnormalities in the nervous system?

Neurogenic pain (C) Signup and view all the answers

What distinguishes psychogenic pain from somatic and neurogenic pain?

It is the only type without an apparent cause. (C) Signup and view all the answers

Which option correctly describes the nature of neurogenic pain?

There may be trigger zones associated. (D) Signup and view all the answers

How does the localization of somatic pain differ from neurogenic pain?

Somatic pain is localized to affected regions, and neurogenic pain is specific to nerve distributions. (B) Signup and view all the answers

Which symptom is typically associated with psychogenic pain?

History of psychic stress. (B) Signup and view all the answers

Which characteristic is NOT typical of neurogenic pain?

It is usually acute. (B) Signup and view all the answers

What type of pain may often be referred to neighboring structures?

Somatic pain (C) Signup and view all the answers

Study Notes

Painful Jaw Diseases

Fractures, Osteomyelitis, Infected cysts, Malignant neoplasms, Sickle cell infarcts are all painful jaw diseases.
Pain in edentulous patients: Denture trauma, excessive vertical dimension, diseases of the denture bearing mucosa, diseases of the jaws, and teeth or roots erupting under a denture can all cause pain in edentulous patients.
Postoperative pain: Alveolar osteitis (dry socket), fracture of the jaw, damage to the TMJ.Osteomyelitis, and damage to nerve trunks or involvement of nerves in scar tissue can cause pain after surgery.
Pain induced by mastication: Diseases of the teeth and supporting tissues, diseases of TMJ, pain dysfunction syndrome, temporal arteritis, trigeminal neuralgia (rarely), and salivary calculi can induce pain during mastication.
Pain from extra-oral disease (referred pain): Diseases of the maxillary antrum like acute sinusitis and carcinoma, particularly when it involves the antral floor, diseases of salivary glands like acute parotitis, salivary calculi, Sjogren’s syndrome, and malignant neoplasms, and diseases of the ears like otitis media, neoplasms, and myocardial infarction can cause referred pain to the jaw.

Neurological Diseases

Trigeminal neuralgia: Characterized by paroxysmal and severe pain confined to the distribution of one or more divisions of the trigeminal nerve. The pain is sharp, stabbing, and lasts for seconds or minutes. A trigger zone exists, where stimuli like touching, cold air, or tooth-brushing can provoke an attack.
Glossopharyngeal neuralgia: This rare condition is characterized by pain similar to trigeminal neuralgia, but felt in the base of the tongue and fauces on one side. The pain can radiate deeply into the ear. The pain is sharp, lancinating, and transient, typically triggered by swallowing, chewing, or coughing.
Post herpetic neuralgia: Up to 10% of patients who have trigeminal herpes zoster, particularly if elderly, may develop persistent neuralgia. The pain is more variable in character and severity than trigeminal neuralgia, typically persistent rather than paroxysmal.
Intracranial tumors: Pain resembling trigeminal neuralgia can rarely be caused by intracranial tumors. Features suggesting an intracranial lesion are associated sensory loss, especially if associated with cranial nerve palsies.
Bell’s palsy: This is a common cause of facial paralysis, probably resulting from compression of the facial nerve in its canal due to inflammation and swelling. It is often caused by a viral infection, particularly herpes zoster. Pain in the jaw sometimes precedes the paralysis or there may be numbness in the side of the tongue.

Muscular Pain

Myofascial pain dysfunction (MFD), TMJ pain dysfunction (TMPD), Facial arthromyalgia (FAM): These share a triad of common symptoms: jaw clicking, jaw locking (or limitation of movements), and orofacial pain. These symptoms appear to be related to muscle spasms and subsequent ischemic pain arising from stress, joint damage, or habits like tooth clenching or grinding.
Etiopathogenesis: Trauma and stress are thought to predispose through increasing tension in the masticatory muscles.
Gender predominance: Females
Age: Teens and up to 40 years
Extraoral: Headache, neck aches, and lower back pain may be present.

Psychogenic Diseases

Psychogenic (atypical) facial pain: Women of middle age or older are mainly affected. Absence of organic signs, poorly localized pain, bizarre descriptions of pain, delusional symptoms, lack of response to analgesics, unchanging pain persisting for many years, lack of any triggering factors.
Burning mouth syndrome: Middle aged or older women are mainly affected. No visible abnormality or evidence of organic disease, no hematological abnormality, pain typically described as burning, persistent and unremitting soreness without aggravating or relieving factors, no response to analgesics, bizarre patterns of pain radiation inconsistent with neurological or vascular anatomy, sometimes bitter or metallic taste associated, associated depression, anxiety or stressful life situation, obsession with symptoms which may rule the patient’s life, constant search for reassurance and treatment by different practitioners.
Psychogenic dental pain (atypical odontalgia): This is a less common variant of atypical facial pain. Pain is often precisely localized in one tooth or in a row of teeth, sensitive to heat, cold, or pressure. If dental disease is found treatment has no effect, or if the tooth is removed, the pain moves to an adjacent tooth.

Pain Classification

Somatic pain: due to noxious stimulation of normal neural structure that innervate body tissue.
Neurogenic pain: due to pathology or abnormality in the neural structures themselves (within the nervous system), i.e. neuropathy
Psychogenic pain: due to psychic stress.

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Description

Explore various painful jaw diseases including fractures, osteomyelitis, and more. This quiz also covers pain in edentulous patients and postoperative complications. Learn about the causes and management of pain related to mastication and extra-oral diseases.